JBSA UNESCORTED ACCESS REQUEST 220920 Word Version.docx

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Updates to Announcement: Medical Support Team Post DHA Industry Day - Presentation Slides & Small Business Contacts
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W9127S23R6002
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This document is an unescorted access request form for Joint Base San Antonio installations. The form collects sponsor and visitor information for security screening purposes to grant unescorted installation access. It requests the sponsor's name and contact details, access category such as contractor or personal visitor, locations and timeframes for access, and the reason for access. Visitor information includes full name, date of birth, identification details, and country information. The form is used to establish identity and fitness for unescorted entry and will be vetted by security personnel at the visitor center using national law enforcement databases prior to access approval.

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UNESCORTED ACCESS REQUEST

AUTHORITY: Title 10, United States Code 8012. PRINCIPAL PURPOSE: To assist security personnel in establishing a fitness determination through the identity proofing and vetting process. ROUTINE USES: To be utilized by personnel requesting to obtain guest installation access pass for unescorted access to Joint Base San Antonio (JBSA) installations or for special one-time events. DISCLOSURE: Disclosure of the requested information is voluntary; however, failure to provide information may result in denial of request or the refusal by the Security Forces Squadron, Installation Access Control Section to permit access to the installation.

"FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b) (6) applies.

This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure."

SPECIAL SECURITY REQUIREMENTS: : IAW DoDM-5200.08 Volume 3, AFMAN 31-101 Volume 3, paragraph 1.1.g.(1)(b), It is the sponsoring organization's responsibility to ensure the visit is properly recorded and documented in the FVS, and the local AFOSI unit is coordinated with in advance of the official foreign visitors' arrival and prior to their departure from the installation. On the day of visit and when the FOREIGN VISITORS visitors have departed the installation, email AFOSI, at AFOSI.Det403@us.af.mil indicating time of arrival and departure from the installation.

The following information has been provided to aid in the completion of the Unescorted Access Request. Section I: Sponsor Information.

Block 1. Title The sponsors title (ie; Mr., Ms., Mrs., or associated rank of Military/GS employee). Block 2. Last Name, First Name MI (Full name of sponsor, use format assigned).

Block 3. Duty Phone (Office number you can be reached at during business hours).

Block 4. Cell/Home Phone (Phone number you may be reached at during requested access times for your guests). Block 5. DoD ID Number (Assigned number on your DoD ID Card-This is required to fully identify you in DBIDS).

Block 6. Organization/Home Address (If you are sponsoring for a government purpose use your organization. If it is for personal reasons use your home address).

Block 7. Email Address (email submissions will be sent encrypted utilizing a .mil email address).

Section II: Access Details.

Block 8. Category for Access (Check the category of your guest).

Block 9 Location (Check which location(s) in the JBSA area you are requesting your guests to have access to – Must be a valid need for entry to these locations. Contractor/Vendors must provide contract number stating access locations are required).

Block 10. Time Frame From Date (Start date of visit/contract, etc…) To Date (End date of visit/contract, etc…)

From Time (Start time of visit or if continual access, start time each day) To Time (End time of visit or if continual access, end time each day)

Days of Week (Days of week entry is required - If visiting select day(s) visit will take place, if continual access is required – actual days of work required to be present)

Block 11. Reason for Access. Provide specific reason for access (ie; Meeting, Tow Truck, Pop-A-Lock, Taxi, Wedding, Family visit, etc…). Block 12. Identify the Visiting Organization, Name of Event or if Contractor: Company Name (Prime and Sub Contractor), Contract Number and Contract Period.

Block 13a, b, c: Sponsor completes each block. Must be legible when completed manually.

Section III: Visitor Center Use Only.

Section IV: Foreign Disclosure Office Use Only. Section V: Guest Information.

FOREIGN VISITORS must be processed through the Foreign Disclosure Office. Email completed form to 502SRG.MAS.JBSA_ForeignRequest@us.af.mil

For more than 20 visitors [Special Event] use continuation sheets).

Block 16. Fill in the blocks [alphabetical order] for all visitors 18 years of age or older.

Last Name, First Name MI (Full name of visitor, use format assigned). DOB: Date of Birth (Use format assigned).

Country (Country of birth for foreign visitors).

ID Type: Must be a valid form of photo ID. Below are acceptable forms. Use the corresponding number when making your selection.

1 = Driver's License 2 = State Identification Card 3 = Veteran's Identificat ion Card 4 = Passport/Visa 5 = Permanent Residence Card 6 = US Citizenship & Immigration Services 7 - Foreign Visitor

ID Number (The associated number assigned to the ID Type) Country of Issue (Country where identification was issued) State of Issue (State where identification was issued) If a tracking number is assigned, the sponsor will relay the number to their guest(s) for announcement at a visitor center. This will allow the Visitor Center Personnel to track completed paperwork for issuance of an access credential.

JBSANANTONIO Form 7, 20211020 (Prescribed by: JBSANANTONIOI 31-1131)

UNESCORTED ACCESS REQUEST

I. SPONSOR INFORMATION

1. TITLE
2. LAST NAME, FIRST NAME, MI
3. DUTY PHONE
4. ALTERNATE CONTACT NUMBER
5. DOD ID NUMBER
6. ORGANIZATION/HOME ADDRESS
7. EMAIL ADDRESS

II. ACCESS DETAILS

8. CATEGORY OF ACCESS

Contractor/Vendor Personal Services Delivery/Pick-Up (Ex: Pizza Delivery/.Non Driver Status)

Visitor/Volunteer Special Event Foreign National

9. LOCATION

JBSA-FSH JBSA-SAMMC

JBSA-CB

JBSA-LAK

JBSA-RND

10. TIME FRAME
From Date:Sunday

From Time: Monday

Tuesday

Wednesday To Date: Thursday

To Time: Friday

Saturday

11. REASON FOR ACCESS (Be Specific)

12. CONTRACTED COMPANY SPONSORED OR SPECIAL EVENT NAME

13a. DATE OF SIGNATURE
13b. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF SPONSOR
13d. SIGNATURE

III. VISITOR CENTER USE ONLY

14a. TRACKING NUMBER

14b. RECEIVED DATE

NCIC III

SFMIS

ALERTS

TSDB

14c. VETTED DATE 14d. POSTED DATE (For EAL Use)

14e. ECP POSTED LOCATION (For EAL Use)

14f. DATE OF SIGNATURE
14g. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER
14h. SIGNATURE

IV. FOREIGN DISCLOSURE OFFICE (FDO) USE ONLY

15a. CASE NAME

15b. VETTED DATE

Approved Denied

15c. DATE OF SIGNATURE
15d. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER
15e. SIGNATURE

UNESCORTED ACCESS REQUEST

V. GUEST INFORMATION

16. Enter information for all persons 18 years of age or older (in alphabetical order). Refer to page 1 for instructions.

TRACKING NUMBER

S O R T
Last Name, First Name, MI
DOB (DD/MMM/YY)
Country of Birth
ID

Type

ID

Number

Country of Issue
State of Issue

VCC Use Only

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